Bolivia: Child Survival with Dignity

1
Bolivia Child Survival with Dignity

• Dr. Álvaro Muñoz-Reyes Navarro
• Minister of Health and Sports
• London, December 2005

2
Overview of the presentation

• The state of child health in Bolivia
• Response of the health system
• Removing financial barriers to access
• Increasing coverage through neonatal and
  Community IMCI
• Building national and local alliances for
  sustainability
• Implications for health policies

3
Trends in Child Mortality in Bolivia
The state of child health in Bolivia
MDG 4, Objective 5
Source DHS 1989,1994,1996,2003
4
National Insurance for Motherhood, Infancy and
Childhood (SNMN) May 1996
Response of the health system
Evolution of the Public Health Insurance Model to
SUMI
Maternal and Child Universal Health Insurance 21
November 2002
Basic Health Insurance 31 December 1998
2005
1996
Beginning with SBS (1998), the IMCI strategy was
completely incorporated
5
The importance of an effective legal framework

• State and Local Governments with greater social
  responsibility and financial resources
• Greater efficiency and efficacy in management
• Redistribution of public revenues
• Greater participation and control by social
  stakeholders

Law of Administrative Decentralization
Law of Popular Participation
Hydrocarbon Tax
Law of National Dialogue
Law of SUMI
6
Financing of SUMI
100 National Revenues National Customs and
Internal Taxes
Complementary Resources

• National Liability Fund
• -Dialogue Account 2000-

• Direct Taxes on Hydrocarbons

Source Bolivia MOH
7
Maternal and Child Universal Health Insurance
(SUMI)

• Is a State Policy created to reduce the morbidity
  and mortality of mothers and children
• Improves access and eliminates economic barriers
  to health services
• Is the main prioritized policy of the Ministry of
  Health and Sports
• Is a component of the Bolivian Poverty Reduction
  Strategy
• Is the principal means to reach the MDG
  objectives in health

8
SUMI coverage according to place of residence,
Bolivia - 2004
Urban Population 62.4
Source Bolivia MOH 2005
9
Conceptual elements in Community - IMCI
Community Context
Health System
Individual Change
SUMI
Community Dialogue
Collective Action
Impact
Social Change
Application of key practices in the care of the
child and the newborn
10
Strategic action lines in Community-IMCI
Strengthening the link between the community
and health facilities
Engagement of social agents
Development of alliances within and
between sectors
Families and the community apply the key
practices in the care of the child and the newborn
Community mobilization and surveillance
Home visits
11
Results from the Community- IMCI component

• Achieved the participation and empowerment of
  social agents in the promotion of key practices
• Strengthened the link between health facilities
  and the community
• Stimulated intersectoral efforts

A focus only on Community Health Workers (CHW) is
not sufficient to improve family practices
Source Red Cross, PAHO/WHO. Community IMCI
Evaluation. 2005. Plan International Bolivia,
BASICSII. 2002
12
Neonatal Community-IMCI Selected Results
Source Save the Children/SNL, 2004
13
The alliances in support of children and newborn
Inter-Agency Coordination Committee
MOH- bilateral and multilateral cooperating
agencies
National Alliance for the Community IMCI scale-up
MOH- PAHO/WHO-UNICEF-USAIDPROCOSI (Network of
NGOs) and PROSIN/USAID - Red Cross - Plan
International
Central and Departmental Levels
The First Lady's Office-MOH-Other
ministries-NGOs-Cooperating Agencies-Womens
organizations
Inter-Institutional Council of Safe Motherhood
Education- Neighborhood Groups- Community health
workers- Municipalities-Mothers Clubs NGOs,
other local organizations
Community IMCI and Newborn
Local Level
14
The alliances in support of children and newborns
have facilitated

• Mobilization of human and economic resources
• Synergy of efforts and harmonization of
  interventions
• Greater possibility of sustaining the key
  interventions
• Incorporation of new social agents and other
  sectors
• Promotion of local development

15
Implications for health policy

• Access
• Elimination of economic barriers improves access
  to healthcare
• Prioritization of excluded population groups
  (indigenous, rural area habitants and others)
• Coverage
• One must seek to improve the quality of care in
  order to increase utilization of services
• Strategies should be oriented toward user
  (client) satisfaction and focused on
  intercultural, gender or generational
  perspectives
• Policies should prioritize interventions in favor
  of neonatal health integrated with maternal
  health
• Sustainability
• Alliances should be in harmony with national
  policies of health
• SUMI should motivate greater social participation

Boys and Girls Have the Right to a Life.a Life
with Dignity